I have no relevant knowledge or expert opinion regarding the motivation of those associated with Garrett Holeve, the 23-year-old amateur MMA fighter from Florida with Down syndrome recently featured on ESPN’s “Outside the Lines.” The social commentary related to this feel-good story doesn’t interest me much, but the potential medical issues are a very different matter.

Down syndrome (Trisomy 21) is the most common chromosomal disorder in humans. Many people are familiar with the facial characteristics and cognitive issues (IQ) associated with Down syndrome, but some of the lesser-known traits need to be addressed when we begin to discuss potential participation in competitive full-contact MMA.

First and foremost, was there a thorough pre-fight medical exam performed by a competent team of physicians that included a cardiologist, ophthalmologist and fellowship-trained spinal surgeon to evaluate issues specific to people with Down syndrome?

I ask because people with Down syndrome have an increased incidence of:

Serious heart defects (about half the population with Down syndrome)

Increased eye pressure (known as glaucoma, which may render the eye more susceptible to trauma from strikes)

Ligamentous laxity (“double jointed”), which is important in assessing the safety of joint locks (armbars, heel hooks, etc.)

Specific ligamentous laxity of the neck (cervical spine) potentially creating atlantoaxial instability, which can lead to spinal cord compression and death

There is a serious debate that seems quite one-sided as to the relative safety of allowing elective blunt force trauma to the head of individuals with documented and/or suspected cognitive issues. Should you allow war fighters with traumatic brain injuries (TBI) to return to combat duties? Is it safe to allow athletes with seizure disorders (epilepsy) to compete in contact and combat sports? Is it safe to allow kids with cerebral palsy (CP) to play soccer or lacrosse? What about children with ADHD?

Not so easy, is it?

Currently, the vast majority of medical literature and professionals do not support the participation of individuals with significant cognitive issues or TBI in combat and contact sports due to the potential for serious brain injury.

In light of Holeve’s case and potentially other ones, I have a few questions I would like answered:

Was a proper pre-fight medical examination performed with special attention to the issues specific to an individual with Down syndrome?

Were Holeve’s parents made aware of the potential risks?

Does the Florida State Boxing Commission oversee/monitor amateur MMA – and how well?

Why do Florida and Texas seem to be such popular destinations for dubious promotions?

Why do so many people still believe that all state athletic commissions have the resources and are up to the task of safely and effectively regulating all of the sports in their jurisdictions?

Dr. Johnny Benjamin is MMAjunkie.com’s medical columnist and consultant and a noted combat-sports specialist. He is also a member of the Association of Boxing Commissions’ MMA Medical Subcommittee. Dr. Benjamin writes an “Ask the Doc” column approximately every two weeks for MMAjunkie.com. To submit a question for a future column, email him at askthedoc [AT] mmajunkie.com, or share your questions and thoughts in the comments section below. You can find Dr. Benjamin online at www.drjohnnybenjamin.com, and you can read his other sports-related articles at blog.drjohnnybenjamin.com.